Traumatic brain injury (TBI) is a public health crisis for children in the US and worldwide. There are no proven therapies to treat TBI, and evidenced-based guidelines have been developed over the past 2 decades to guide best current practices. Yet, implementation strategies are lacking. In prior work, we found that adherence to the TBI guidelines was associated with 6% better outcomes in 5 leading U.S. academic centers. However, TBI guideline adherence remains low and the guidelines have limitations related to recommendation applicability across health care systems and across countries. In response, we developed and pilot tested an innovative multilevel Pediatric Guideline Adherence and Outcomes (PEGASUS) program to increase TBI guideline adherence. Preliminary data show that barriers to TBI guideline adherence are remediable and TBI guideline based intensive care benefits outcomes. This proposal is a collaboration between U.S. and Argentine TBI clinical investigators dedicated to understanding TBI guideline adherence. The overarching aim of this proposal is guided by the Theoretical Domain Framework. We propose to conduct a pragmatic cluster randomized controlled trial of the PEGASUS program (intervention) and to improve TBI guideline adherence (main outcome) in severe pediatric TBI across six Argentine study sites. Using mixed-methods, we propose 3 Specific Aims: 1) Determine the relationship between PEGASUS program implementation and TBI guideline adherence (Aim 1a), and assess system, provider, patient, implementation and guideline factors associated with TBI guideline adherence (Aim 1b), 2) Create a value stream map that readily identifies value added process of care associated with TBI guideline adherence, and 3) Use computer simulation to develop and disseminate a real world best practices blueprint for TBI guideline adherence. This is a necessary advance and a step towards implementing guideline-based TBI care for children who suffer from TBI.

Public Health Relevance

Pediatric traumatic brain injury (TBI) is the leading killer of children worldwide but effective treatments for TBI are limited. Although evidenced-based pediatric TBI guidelines exist, adherence to these guidelines is low, leading us to develop a new Pediatric Guideline Adherence and Outcomes (PEGASUS) program to increase TBI guideline adherence. We propose to test the PEGASUS program's ability to improve TBI guideline adherence and outcomes.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
1R01NS106560-01A1
Application #
9678497
Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Bellgowan, Patrick S F
Project Start
2019-01-01
Project End
2023-12-31
Budget Start
2019-01-01
Budget End
2019-12-31
Support Year
1
Fiscal Year
2019
Total Cost
Indirect Cost
Name
University of Washington
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195